The Effects of Development Assistance on Sexual and Reproductive Health Services in Low- and Middle-Income Countries: A Cross-Country Panel Data Analysis

Using data on 119 low- and lower-middle income countries from 2002 to 2020, we apply fixed-effects (FE) methods to evaluate the impacts of three different classifications of development assistance on access to three types of sexual and reproductive health (SRH) services: access to skilled birth attendance, prevalence of modern contraceptives, and coverage of antiretroviral therapies against HIV/AIDS. The results suggest that aid has had a small, but positive effect on these outcomes over this period. For example, SRH aid has increased service coverage rates by between 0.190 and 0.628 percentage points. The results also indicate that the effect of aid has improved across the period and is larger in low-income countries compared with lower-middle income countries. The findings also indicate that bilateral aid may be somewhat more effective than other types of aid. Importantly, the results suggest that development assistance is more effective if it reaches a certain share of overall health spending. The findings are robust to a series of sensitivity checks. The results of the study lend support to the continued allocation of aid to low-income countries to support the provision of sexual and reproductive health services. Both providers and recipients of SRH aid would be advised to identify ways to improve the effectiveness of development assistance in this area. ### Competing Interest Statement The authors have declared no competing interest. ### Funding Statement This study was funded by the Swedish public agency The Expert Group for Aid Studies. ### Author Declarations I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained. Yes I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals. Yes I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance). Yes I have followed all appropriate research reporting guidelines, such as any relevant EQUATOR Network research reporting checklist(s) and other pertinent material, if applicable. Yes All data used in the study are open available from the sources provided in the text.